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Medicaid expansion proposal introduced

Advocates of expanding Medicaid coverage to more low-income Nebraskans introduced a proposal to do that in the Legislature Wednesday. They say it will pay for itself; others are skeptical.

Medicaid was originally going to be expanded across the country under the federal Affordable Care Act. But last year’s U.S. Supreme Court decision upholding that act made Medicaid expansion optional for the states.

Lincoln Sen. Kathy Campbell said Nebraska should expand its program to provide health insurance for more low income citizens. And she likened the effort to other times Nebraskans help each other. “Nebraskans time and again pitch in after floods and tornadoes to support their neighbors and help them rebuild,” she said. “This is an opportunity to make a smart investment in our state’s economy and workforce. To make our state’s health systems stronger and more cost-effective. And to ensure that hard-working Nebraskans will be healthier. We can be there for our neighbors.”

Campbell estimated opting in to the federal program could cover 54,000 more people at income levels of up to $26,300 for a family of three, for example.

The federal government is supposed to pay for the full cost of expansion for the first three years, eventually declining to 90 percent by the year 2020. Gov. Dave Heineman has said that will force the state to divert funds from education and other needs. In a news conference following his State of the State speech last week, Heineman predicted the cost at “hundreds of millions of dollars on top of what we’re doing.”

“ I don’t think we can afford that,” the governor said. “I think we should go very slowly relative to that. We can have this conversation a year or two years down the road about the expansion.”

Senators supporting the expansion said that, combined with other parts of federal health reform, expansion would actually save the state money. And Omaha Sen. Bob Krist said Nebraska taxpayers should get back what they’re paying for the Affordable Care Act.

“The time has passed to discuss the merits or debate the merits of the Act,” Krist said. “The only debate or question left is whether the leadership of this state allows the federal government to keep our health care cash money, or seize(s) the opportunity to bring those monies back to care for Nebraskans.”

Sen. Jim Smith of Papillion is skeptical about expansion. In a separate interview, Smith questioned the effect of expansion on existing Medicaid recipients. “When you have such a large scale increase and expansion of citizens covered under it, my concern is how are we going to meet those needs with the existing pool of resources – doctors and hospitals and such?” he said.

Health care providers already complain they’re not adequately compensated for caring for Medicaid patients. The Affordable Care Act raises compensation for some doctors, but only for two years. It also offers hospitals the possibility, if Medicaid is expanded, of more patients with insurance. But at the same time it promises to cut other payments to help hospitals pay for caring for people without insurance.

The Medicaid bill was one of more than 160 introduced on the last day to submit new proposals this year. Among the others was a proposal by Sen. Ernie Chambers of Omaha to abolish the death penalty and replace it with life in prison without possibility of parole.

All told, the Legislature will have 655 bills and 6 proposed constitutional amendments to consider between now and when it adjourns in June.